| NPI | 1760653794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2025-04-23 |